TELEMEDICINE REIMBURSEMENT:MEDICAID AND PRIVATE PAYERS
Oklahoma Telemedicine Conference 2014: Telehealth TransitionOctober 16, 2014Cynthia Scheideman-Miller, MHSAHeartland Telehealth Resource Center
Who we are
Heartland Telehealth Resource Center is an independent and impartial resource center that is here to assist in the development of sustainable telehealth programs and networks.
Heartland is the regional TRC for Kansas, Missouri and Oklahoma.
HTRC activity is supported by grant number G22RH20214 from the Office for the Advancement of Telehealth, Office of Health Information Technology, Health Resources and Services Admin, DHHS.
Who pays for Telehealth?
Federal and state programs Medicare - with restrictions Medicaid/ CHIP (SoonerCare) – with
restrictions
Private Insurance Programs
Contracted Services
Distant vs Originating
Distant Site:Where the provider is
Originating Site:
Where the patient is
Medicare Medicaid
Hospital
Office of a physician or practitioner
Critical Access Hospitals (CAH)
Rural Health Clinics (RHC)
Federally Qualified Health Centers (FQHC)
Hospital or CAH-based Renal Dialysis Centers (including satellites)
School
Outpatient Behavioral Health Clinic
Community Health Center
Indian Health Service facility, a Tribal Health facility, or an Urban Indian Clinic (I/T/U)
Authorized originating site
Medicare MedicaidPhysician
Advanced Registered Nurse Practitioners
Physician Assistants
Genetic Counselors
Licensed Behavioral Health Professionals
Registered Dieticians
I/T/U’s with specialty service providers as listed above
Nurse midwife
Clinical Psychologist
Nutrition Professional
Clinical Nurse Specialist
Clinical Social Worker
Authorized distant site specialty Providers
Medicare
Medicaid
Private Payer
Pays for telehealth
Requires a modifier
Patient must be at a rural site*
Providers specified
Primary Care Only for I/T/U
Only reimburses for specific CPT codes
Interactive telecommunication network preapproved
Telemedicine visits counted toward the applicable benefit limits for these services
Store & Forward
Non-covered services: telephone conversation, E-mail, FAX
Patient must be in Oklahoma at time of teleconsult
Reimbursement Comparison
*Medicare defines “Rural “as a non-MSA county . Medicaid defines “rural “as a county with a population of less than 50,000 people.
Medicaid Telehealth/ CodesTelehealth Service CPT/HCPCS Codes
Assessment H0031
Office or other outpatient visits 99201-99215
Behavioral Health Service Plan Development
H0032
Individual Medical Nutrition Therapy
97802-97803
Individual psychotherapy 90832-90834, 90837-90838; H0004
Pharmacologic management Appropriate E/M code
Psychiatric diagnostic interview examination and testing
90791-90792;96101-96103;96118-96120;96110-96111;90887
www.okhca.org “Soonercare Reimbursement Checklist for Telemedicine”
Clinical fee services: same as the current fee schedule amount for services provided without telemedicine. Use appropriate HCPS code with modifier.
Telemedicine/telehealth Modifiers (distant site only): GT for interactive audio and video telecommunications system Does not apply to X-ray, ultrasound or electrocardiogram as they are
not considered telemedicine.
Telehealth Billing: Medicaid/Distant Site
Dual Eligibles If a service is eligible under Medicare
the Medicare payment rate applies and Medicaid would cover some portion of the coinsurance.
If the service isn’t eligible under Medicare Confirm with OHCA it is covered Have the beneficiary sign an Advanced
Beneficiary Notice if a Medicaid copayment is required
Source: Aaron Fischbach , Policy Coordinator, HRSA
Originating Site Fee: Originating site must be Rural. Only the originating site will bill for a facility fee. HCPCS code "Q3014, ($24.24 in 2012)
“telehealth originating site facility fee"; short description "telehealth facility fee.”
The type of service for the telehealth originating site facility fee is "9, other items & services”
Telehealth Billing: Medicaid/Originating Site
Cynthia Scheideman-Miller
Questions?
Telemedicine/Medicaid specific questions:
Adolf Maren
(405)522-7300